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Community Paramedicine Pilot Programs: Lessons From Maine, Karen B. Pearson MLIS, MA, George Shaler MPH 2017 University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center

Community Paramedicine Pilot Programs: Lessons From Maine, Karen B. Pearson Mlis, Ma, George Shaler Mph

Access / Insurance

Community paramedicine programs are beginning to flourish across the nation, and the need to provide demonstration or pilot programs is essential to providing a consistent and high-level standard for this model of care. While the overarching goals are to align with the Triple Aim, piloting a community paramedicine program also allows each community to develop and implement a program tailored to the healthcare needs of their specific community. A successful program builds the evidence base that can then be used to create legislative change necessary to financially sustain this model of care across the healthcare delivery system. This article provides ...


Women’S Sexual Fantasies In Context: The Emotional Content Of Sexual Fantasies, Psychological And Interpersonal Distress, And Satisfaction In Romantic Relationships, Sarah Constantine 2017 The Graduate Center, City University of New York

Women’S Sexual Fantasies In Context: The Emotional Content Of Sexual Fantasies, Psychological And Interpersonal Distress, And Satisfaction In Romantic Relationships, Sarah Constantine

All Graduate Works by Year: Dissertations, Theses, and Capstone Projects

Background: Psychoanalytic thinkers propose that aspects of an individual’s sexual fantasies are related to her psychological and interpersonal functioning. The present study aims to elucidate the significance of sexual fantasies with respect to women’s emotional and interpersonal lives. The study evaluated a model, which hypothesized that internal representations of self and others (e.g. attachment security, maturity of object relations) along with psychological and interpersonal factors would predict both the emotional content (guilt, fear, affection) of written sexual fantasy narratives, and overall romantic satisfaction in heterosexual women. Methods: Five hundred and thirty four women completed self-report questionnaires online ...


Clinicians’ Perspectives And Utilization Regarding Harm Reduction In Nursing Practice In Care Of Persons With Addiction: A Literature Review, Audrey Killarney 2017 DePaul University

Clinicians’ Perspectives And Utilization Regarding Harm Reduction In Nursing Practice In Care Of Persons With Addiction: A Literature Review, Audrey Killarney

Grace Peterson Nursing Research Colloquium

Clinicians’ perspectives and utilization regarding harm reduction in nursing practice in care of persons with addiction: A literature review

Audrey Killarney, BS

Prof. Michelle Neuman, MSN, APN, RN

NSG 598: Graduate Research Synthesis

18 August 2017

Introduction

Background & Significance

Harm reduction is a concept best described as the recognition that individuals will engage in unhealthy behaviors, and the goal is to minimize the associated potential harm. (Stockwell, Reist, Macdonald, Benoit, & Jansson, 2010). Classically, it was used an alternative model of care for treating smokers and controlling the spread of HIV and hepatitis B (Henwood, Padgett, & Tiderington, 2014). However, in the context of medicine, harm reduction allows the clinician to accept that the patient may continue a harmful behavior, and their duty as a clinician is to minimize the relative risks and harms associated with that behavior (Öztuna et al., 2014). Most recently, harm reduction has been introduced as a means to address treatment for persons with addiction (Aldridge, 2012). These patients carry complex medical and social histories, for which traditional “treatment first” approaches may not be appropriate (Henwood et al., 2014). For example, Draanen et al. (2013) found an associated mental disorder in over 1/3 of patients who abuse alcohol, and over half of patients who abuse drugs. This finding supports the hypothesis that patients with severe mental illness often self-medicate with drugs and/or alcohol to control their psychosis (Henwood et al., 2014).

Previous studies have consistently reported that patients with addiction are more likely to be immune-compromised and have poor nutritional status, which can greatly affect their response to medical treatment (Bartlett, Brown, Shattell, Wright, & Lewallen, 2013). These individuals are also more likely to delay seeking medical treatment for acute issues, resulting in hospital visits for far more severe and advanced illnesses (Ford, Bammer, & Becker, 2008). Harm reduction allows for clinicians to assess other aspects of a patient’s well-being, such as secure housing, employment, and social support, which may contribute to recovery and/or relapse (Henwood et al., 2014).

Harm reduction holds great significance in current nursing practice given the recent rise of substance abuse and overdose deaths in the United States. In 2014, it was estimated that abuse of tobacco, alcohol and drugs cost the United States over $700 billion in loss of productivity, healthcare, and crime (National Institute on Drug Abuse, 2015). These numbers are significant, as harm reduction interventions in Canada have been able to alleviate hospital-based costs, reduce ED visits, as well as reduce overnight hospital stays (Draanen et al., 2013). A growing problem in the United States surrounds the epidemic of opioid overdose. Heroin overdoses account for the fastest growing group of overdose deaths, with a 6-fold rise over the period of 2001-2013 (National Institute on Drug Abuse, 2015). In response to rising heroin overdose rates, overdose education and naloxone distribution (OEND) programs are increasing nationwide. These types of programs are commonly sponsored by the Harm Reduction Coalition, as they seek to reduce potential risks and mortality associated with drug use. This finding further supports the argument for inclusion of harm reduction in the care of persons with addiction (Lewis et al., 2016).

Nurses in particular, are positioned to experience situations in which harm reduction strategies may be appropriate. Nursing staff are frequently involved in patient education, and re-education, of hospitalized patients; while an individual may not be ready to receive treatment, nursing staff could be qualified to provide information regarding self-help groups (Bartlett et al., 2013). Additionally, nurses conduct many of the initial screenings during hospitalization; these screenings include alcohol and drug abuse questionnaires that provide a bridge to discussions regarding use and healthy use of alcohol, prescription drugs and illicit substances (Bartlett ...


The Benefits Of And Barriers To Psychiatric Advance Directive Implementation, Lauren Haindfield 2017 DePaul University

The Benefits Of And Barriers To Psychiatric Advance Directive Implementation, Lauren Haindfield

Grace Peterson Nursing Research Colloquium

The Benefits of and Barriers to Psychiatric Advance Directive Implementation

Lauren Haindfield

Faculty Sponsor: Dr. Barbara Harris

Background: Psychiatric advance directives can be beneficial for patients with mental disorders, but their implementation is limited in large part due to a knowledge gap.

Objectives: The purpose of this integrative literature review was to identify both the benefits of and barriers to psychiatric advance directives.

Methods: This integrative literature review used the databases of CINAHL, PubMEd, and PsychInfo. Search terms included pad implementation, barriers to pad implementation, psychiatric advanced directives, benefits of psychiatric advanced directives, and current pad practices.

Results: PAD implementation ...


Barriers To Medication-Assisted Opioid Recovery: An Integrative Review Of Literature, Emily Miller 2017 DePaul University

Barriers To Medication-Assisted Opioid Recovery: An Integrative Review Of Literature, Emily Miller

Grace Peterson Nursing Research Colloquium

Abstract

Background: Opioid addiction has become one of the fastest growing epidemics sweeping the world, but despite the use of opioid agonist medication-assisted treatment (MAT) with methadone or buprenorphine having been found to be one of the most effective methods for treatment of this epidemic, there is still a significant gap between the number of people that need MAT and the number of people that actually receive MAT.

Objective: The purpose of this integrative literature review is to explore the barriers that prevent many addicts from receiving MAT and to identify strategies that may assist in eliminating these barriers in ...


Effective Methods For Domestic Violence Screening In The Emergency Department, Megan Bryan 2017 DePaul University

Effective Methods For Domestic Violence Screening In The Emergency Department, Megan Bryan

Grace Peterson Nursing Research Colloquium

Abstract

Background: The CDC reports that one in four women and one in ten men will experience some form of domestic violence in their lifetime that will have either a short-term or long-term impact on their well-being. Often the first place these victims are seen where they can receive help is the emergency department. Objectives: The goal of this systematic integrative literature review was to explore existing literature on domestic violence screening methods used in the emergency department and determine which methods prove most effective. Concurrently, this review examined the barriers to effective domestic violence screening and how nursing education ...


Questionnaire On Childhood Sexual Abuse, Polly A. Hulme 2017 South Dakota State University

Questionnaire On Childhood Sexual Abuse, Polly A. Hulme

Polly Hulme

No abstract provided.


Child Abuse Prevention Training: Introducing A Train-The-Teacher Manual For Child Safety Awareness, Kimmera Wilson 2017 The University of San Francisco

Child Abuse Prevention Training: Introducing A Train-The-Teacher Manual For Child Safety Awareness, Kimmera Wilson

Master's Projects and Capstones

Introduction. In order for the San Francisco Child Abuse Prevention Center community education department to extend the outreach of the Child Safety Awareness (CSA) curriculum, a training manual was created for San Francisco Unified School District (SFUSD) K- 5th grade teachers. This paper evaluates the effectiveness of a train the teacher manual for the child safety lessons.

Methods. A five question tool was developed to survey Kindergarten through 5th grade teachers working at elementary schools in the San Francisco Unified School District. The questions were designed to better understand the needs of the population before creating a resource for them ...


“Do You Think I Should Be Worried?” Building A Call Structure For Hiv(-) Callers To The Nightline, Ivy Epstein 2017 The University of San Francisco

“Do You Think I Should Be Worried?” Building A Call Structure For Hiv(-) Callers To The Nightline, Ivy Epstein

Master's Projects and Capstones

Abstract

San Francisco Suicide Prevention’s HIV Nightline provides emotional support to those living with human immunodeficiency virus (HIV) as well as support and basic medical information around relative risk and testing for who may have been exposed to HIV. Nightline counselors use a harm-reduction model, active listening, reflection of emotions, and encouragement to promote health maintenance and mental health self-care behaviors. Until now, there has been no process to assess whether callers had disproportionate anxiety about HIV given their actual risk level. Consequently, HIV(-) anxious callers could receive inconsistent information. The goal of this improvement study was to develop ...


Mindful Classroom: Developing And Testing Strategies For Resilience Among Urban 7th Grade Students, Alyssa Santos 2017 The University of San Francisco

Mindful Classroom: Developing And Testing Strategies For Resilience Among Urban 7th Grade Students, Alyssa Santos

Master's Projects and Capstones

Introduction: A growing body of research suggests mindfulness-based classroom interventions are an effective, low cost approach to reducing the effects of toxic stress among youth. The purpose of this project was to identify key sources of stress among urban 7th grade students at De Marillac Academy and develop and test mindfulness techniques to actively engage and potentially improve stress management skills among students.

Methods: Five focus groups with students were conducted to assess the most prominent sources of stress inside and outside of school as well as current self-management strategies. Additionally, anonymous online surveys were distributed to 7th grade parents ...


On-The-Spot Mindfulness Based Practices For Addressing Behavior Challenges Among 3rd Graders, Christina Francis 2017 The University of San Francisco

On-The-Spot Mindfulness Based Practices For Addressing Behavior Challenges Among 3rd Graders, Christina Francis

Master's Projects and Capstones

Purpose: The purpose of this project was to introduce and implement a mindfulness based tool that will empower students to manage their stress which contributes to their classroom behavior and allow teachers to minimize the amount of classroom time spent addressing behavior challenges.

Methods: Observations of third grade classrooms, key informant interviews with third grade teachers and community observations were conducted at the Achieve Academy School while throughout the school day.

Results: Findings showed that students would benefit from the implementation of On-The-Spot Mindfulness Based Techniques and Practices by minimizing stress, increasing academic success and improving the overall behavior, social ...


Adapting A Physical Activity Intervention For Youth In A Rural Area: A Case Study, Moya L. Alfonso, Gavin T. Colquitt, Ashley D. Walker, Akrati Gupta 2017 Georgia Southern Universtiy

Adapting A Physical Activity Intervention For Youth In A Rural Area: A Case Study, Moya L. Alfonso, Gavin T. Colquitt, Ashley D. Walker, Akrati Gupta

Moya L. Alfonso

Background: Physical activity offers children and youth many well-documented positive effects on health. The present study adapted a community-based prevention marketing campaign (CBPM), VERBTM Summer Scorecard (VSS) to promote physical activity among minority youth in rural, southeast Georgia. The purpose of this paper is to describe the adaptation process, emphasizing methods used and lessons learned.

Methods: A qualitative study design was used to identify social marketing concepts that informed program adaptation, including two focus groups with 12 children and two focus groups with 14 parents. Qualitative thematic data analysis was used to analyze formative research. The adapted program was implemented ...


Experiences Of Students In Recovery On A Rural College Campus: Social Identity And Stigma, Alison Scott, Ashton Anderson, Kristen Harper, Moya L. Alfonso 2017 College of William and Mary

Experiences Of Students In Recovery On A Rural College Campus: Social Identity And Stigma, Alison Scott, Ashton Anderson, Kristen Harper, Moya L. Alfonso

Moya L. Alfonso

A growing number of college (postsecondary) students are in recovery from addiction to drugs or alcohol. In this article, we discuss the experiences of students returning to a university campus after long-term addiction treatment. We also explore the role of a Collegiate Recovery Program (CRP) in providing support, and in helping the students develop post-addiction identities that will sustain them. To do so, we draw on Goffman’s ideas related to stigma, as well as conceptualizations of identity reconstruction as a practiced, lived experience. Students interviewed faced a double bind; they sought to escape the stigmatized identity of “addict,” but ...


Evaluation Of The Dyad Bonding Dance Model For Mothers And Infants Exposed To Stressful Life Situations, Hadas Vered Weissberg 2017 Lesley University

Evaluation Of The Dyad Bonding Dance Model For Mothers And Infants Exposed To Stressful Life Situations, Hadas Vered Weissberg

Expressive Therapies Dissertations

This study examines the Dyad Bonding Dance (DBD), a dance movement group therapy model developed to improve nonverbal communication between mothers exposed to stressful life situations and their children. The research emphasizes the importance of mother-child attachment relationships and transmission of stress from parents to children via nonverbal communication, which may affect bonding and child health. This qualitative study assessed the experience of dance movement therapists using this novel model. Broad research questions addressed were: (1) What are dance therapists’ experiences with the DBD model, focusing on its impact or lack of impact in improving the dyadic relationship between mother ...


Misperceptions And The Misused Language Of Addiction: Words Matter, Richard Saitz 2017 Boston University School of Public Health

Misperceptions And The Misused Language Of Addiction: Words Matter, Richard Saitz

National Network of Libraries of Medicine New England Region (NN/LM NER) Repository

Despite recognition of addiction as a health condition, terminology used in both layperson and scientific publications is often inaccurate and stigmatizing. National and international efforts are now afoot to encourage the use of terminology that can improve accuracy, reduce stigma, and even improve care. Dr. Richard Saitz from the Boston University School of Public Health will discuss the rationale for terms that should and should not be preferred.


Finding Common Ground: Learning From Leaders Who Have Utilized Conflict Transformation Behaviors In The Mental Health Field In The United States, Tamarah E. Tilos 2017 Brandman University

Finding Common Ground: Learning From Leaders Who Have Utilized Conflict Transformation Behaviors In The Mental Health Field In The United States, Tamarah E. Tilos

Dissertations

Purpose: The purpose of this study was to discover and describe how exemplary leaders establish common ground and produce breakthrough results in the mental health field by utilizing the 6 domains of conflict transformation: collaboration, communication, problem solving, process, emotional intelligence, and ethics.

Methodology: This thematic, phenomenological study was accomplished through examination of the lived experiences of exemplary leaders with firsthand experience transforming conflict and finding common ground. The target population for this study included executive-level leaders of nonprofit organizations, governmental institutions, state and national associations, and private businesses serving adults and children with mental illness, developmental or behavioral disabilities ...


The Impact Of Neonatal Abstinence Syndrome: The View From A Rural Kentucky Hospital, Sydni Fazenbaker Crowell, Allison M. Crump-Rogers, William Crump, LeAnn Langston 2017 University of Louisville School of Medicine Trover Campus at Baptist Health Madisonville

The Impact Of Neonatal Abstinence Syndrome: The View From A Rural Kentucky Hospital, Sydni Fazenbaker Crowell, Allison M. Crump-Rogers, William Crump, Leann Langston

Marshall Journal of Medicine

Abstract

Introduction

Cases of neonatal abstinence syndrome (NAS) increased 3-fold in the United States from 2000 to 2009, with some indication that the problem may be worse in rural areas. The purpose of our study was to report the incidence of NAS in a small rural community with a regional referral hospital and describe aspects of these infants’ NICU stay.

Methods

Using maternal prenatal positive urine drug screens (UDS) as our initial focus, deliveries at 35 weeks or beyond between March 2015 and May 2016 were included. NAS severity score, length of NICU stay, and hospital charges for each infant ...


Using Timelines To Visualize Service Use Pathways To Alcohol Treatment, Lynda Berends, Michael Savic 2017 University of New South Wales

Using Timelines To Visualize Service Use Pathways To Alcohol Treatment, Lynda Berends, Michael Savic

The Qualitative Report

Many people in alcohol and other drug treatment are clients of other services, however there is limited consideration of the combinations and sequences of services and systems that they use. We used data visualization to analyze and re-present findings from a large research project on clients’ service use and referral sources in the year preceding alcohol treatment entry. Data were from 16 “high-end” service users with alcohol problems and analysis involved constructing individual text and timeline summaries and a visual encoding system to show service type and referral source. Three distinct service use pathways were identified and a visual model ...


Adaptation Of Community Health Worker-Delivered Behavioral Activation For Torture Survivors In Kurdistan, Iraq, J. F. Magidson, C. W. Lejuez, T. Kamal, E. J. Blevins, L. K. Murray, J. K. Bass, P. Bolton, Sherry L. Pagoto 2017 Harvard Medical School

Adaptation Of Community Health Worker-Delivered Behavioral Activation For Torture Survivors In Kurdistan, Iraq, J. F. Magidson, C. W. Lejuez, T. Kamal, E. J. Blevins, L. K. Murray, J. K. Bass, P. Bolton, Sherry L. Pagoto

Sherry L. Pagoto

BACKGROUND: Growing evidence supports the use of Western therapies for the treatment of depression, trauma, and stress delivered by community health workers (CHWs) in conflict-affected, resource-limited countries. A recent randomized controlled trial (Bolton et al. 2014a) supported the efficacy of two CHW-delivered interventions, cognitive processing therapy (CPT) and brief behavioral activation treatment for depression (BATD), for reducing depressive symptoms and functional impairment among torture survivors in the Kurdish region of Iraq. METHODS: This study describes the adaptation of the CHW-delivered BATD approach delivered in this trial (Bolton et al.2014a), informed by the Assessment-Decision-Administration-Production-Topical experts-Integration-Training-Testing (ADAPT-ITT) framework for intervention adaptation ...


Does How We Feel About Financial Strain Matter For Mental Health?, Sarah D. Asebedo, Melissa J. Wilmarth 2017 Texas Tech University

Does How We Feel About Financial Strain Matter For Mental Health?, Sarah D. Asebedo, Melissa J. Wilmarth

Journal of Financial Therapy

This study investigated how stress responses to financial strain are related to mental health (i.e., depression) to answer the question: Does how we feel about financial strain matter? Informed by the ABC-X model of family stress and analyzed with data from the Health and Retirement Study (HRS), results reveal that financial strain is significantly related to increased depression; however, financial stress was found to moderate this relationship. Financially strained respondents without a stress response did not have significantly different depression scores than those who were not experiencing financial strain; however, depression scores increased as the stress response to financial ...


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